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Dire need for child psychiatric help in Md.’s rural areas

I remember one Saturday in the middle of winter using my body as a barrier to keep the door shut while calling the after-hour crisis hotline for help. My adolescent daughter, in a psychotic episode, was attempting to get out the door, into the snow, half undressed, wanting to die. The hotline’s response was to run a warm bubble bath for her, and she would calm down.

I remember yelling into the phone that we were “way passed the point of a bubble bath!” They then suggested that I drive her to the emergency room. The thought of an out of control adolescent in a moving car was far worse to me than the bath idea. I was then told to “just call the police.”

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After an hour she finally calmed down. When I called to make an appointment on Monday, the office had no openings, only a wait list. This was the first of many psychotic episodes with six episodes requiring hospitalization.

Her admissions were in Maryland (in Baltimore and Cambridge), Virginia, Delaware and outside of Baltimore to a combined adolescent/adult unit. Our last ER visit was 38 hours in the seclusion room due to no bed availability, and then the only placement available was the combined unit. I assumed the adults would be separated from the children, but to my dismay, we were met by a man in his late 40s standing in the hallway in his underwear. I told the ambulance crew “We are out of here!” The staff rushed over, removed the gentleman and reassured me that they would take great care of my daughter. My choices were that I take her home and risk her killing herself, or leave her at the combined unit. I chose the unit.

There is a dire need across Maryland for child/adolescent psychiatric help for both inpatient facilities and outpatient counseling in rural areas. In April 2019, a white paper was released by the Maryland Health Care Commission Center for Health Care Facilities Planning and Development to inform the public about the state of Maryland’s acute psychiatric services. It listed the number of suicides under the age of 18 in 2008 at approximately 14 deaths, which increased to 21 by 2009. Preliminary results showed that there was a continued increase to 26 adolescent suicides in 2017. The white paper revealed that Maryland has 29 psychiatric hospitals, but only two sites accept children under age of 12, and only five sites accept children ages 13-17. All seven of these sites are located in Central MD. The Western and Eastern Shores of Maryland have no acute psychiatric facilities.

“The recent higher number of deaths could be an indicator that access and availability of psychiatric services for the younger population should be more closely examined, when viewed in the context of limited hospital space, a small number of sites, and some observed increase in the hospital use rate,” researchers concluded.

A state psychiatric facility for adults in Cambridge converted from an adult psychiatric facility to a forensic facility years ago due to a need. Why can’t the state renovate an abandoned adolescent psychiatric facility on the Eastern Shore that could serve all five surrounding counties? Why not incentivize adolescent psychiatric providers to work in underserved rural areas, similar to teachers? Additional incentives could include paying off student loan debt and/ or offering a tax credit for these desperately needed providers to live and work in the underserved areas.

Maryland is not alone. According to the Department of Health and Human Services, in 2016 only 41% of just over 3 million adolescents received treatment. In 2016, there were only 8,300 child/adolescent psychiatrists in practice attempting to help 15 million children and adolescents in the U.S. The demand for help is higher than the help that can be provided. We need to bring this issue to the forefront to our state legislature, and across the country.

Please talk to local hospital administrators about implementing telehealth technology to assist in psychiatric assessments which will aide in decreasing the hold times in emergency rooms. Call and write your local government officials about the need for an adolescent facility on the Western and Eastern shores of Maryland, specifically in Cambridge where there is an abandoned facility at hand. Ask for incentive programs to obtain and retain adolescent psychiatric providers, hospital incentives to invest and create adolescent facilities within their organizations and a streamlined effort for Certificate of Needs for psychiatric beds. We need your voice to help make a difference in the lives of the adolescents in our community.

Jeannine LeMieux (livinglife1965@gmail.com) is a registered nurse on the Eastern Shore of Maryland.

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